Bill Text: IL SB3209 | 2009-2010 | 96th General Assembly | Introduced
Bill Title: Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning hospital access payments.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2010-02-09 - Referred to Assignments [SB3209 Detail]
Download: Illinois-2009-SB3209-Introduced.html
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1 | AN ACT concerning public aid.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Illinois Public Aid Code is amended by | |||||||||||||||||||
5 | changing Section 5A-12.2 as follows:
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6 | (305 ILCS 5/5A-12.2) | |||||||||||||||||||
7 | (Section scheduled to be repealed on July 1, 2013) | |||||||||||||||||||
8 | Sec. 5A-12.2. Hospital access payments on or after July 1, | |||||||||||||||||||
9 | 2008. | |||||||||||||||||||
10 | (a) To preserve and improve access to hospital services, | |||||||||||||||||||
11 | for for hospital services rendered on or after July 1, 2008, | |||||||||||||||||||
12 | the Illinois Department shall, except for hospitals described | |||||||||||||||||||
13 | in subsection (b) of Section 5A-3, make payments to hospitals | |||||||||||||||||||
14 | as set forth in this Section. These payments shall be paid in | |||||||||||||||||||
15 | 12 equal installments on or before the seventh State business | |||||||||||||||||||
16 | day of each month, except that no payment shall be due within | |||||||||||||||||||
17 | 100 days after the later of the date of notification of federal | |||||||||||||||||||
18 | approval of the payment methodologies required under this | |||||||||||||||||||
19 | Section or any waiver required under 42 CFR 433.68, at which | |||||||||||||||||||
20 | time the sum of amounts required under this Section prior to | |||||||||||||||||||
21 | the date of notification is due and payable. Payments under | |||||||||||||||||||
22 | this Section are not due and payable, however, until (i) the | |||||||||||||||||||
23 | methodologies described in this Section are approved by the |
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1 | federal government in an appropriate State Plan amendment and | ||||||
2 | (ii) the assessment imposed under this Article is determined to | ||||||
3 | be a permissible tax under Title XIX of the Social Security | ||||||
4 | Act. | ||||||
5 | (a-5) The Illinois Department may, when practicable, | ||||||
6 | accelerate the schedule upon which payments authorized under | ||||||
7 | this Section are made. | ||||||
8 | (b) Across-the-board inpatient adjustment. | ||||||
9 | (1) In addition to rates paid for inpatient hospital | ||||||
10 | services, the Department shall pay to each Illinois general | ||||||
11 | acute care hospital an amount equal to 40% of the total | ||||||
12 | base inpatient payments paid to the hospital for services | ||||||
13 | provided in State fiscal year 2005. | ||||||
14 | (2) In addition to rates paid for inpatient hospital | ||||||
15 | services, the Department shall pay to each freestanding | ||||||
16 | Illinois specialty care hospital as defined in 89 Ill. Adm. | ||||||
17 | Code 149.50(c)(1), (2), or (4) an amount equal to 60% of | ||||||
18 | the total base inpatient payments paid to the hospital for | ||||||
19 | services provided in State fiscal year 2005. | ||||||
20 | (3) In addition to rates paid for inpatient hospital | ||||||
21 | services, the Department shall pay to each freestanding | ||||||
22 | Illinois rehabilitation or psychiatric hospital an amount | ||||||
23 | equal to $1,000 per Medicaid inpatient day multiplied by | ||||||
24 | the increase in the hospital's Medicaid inpatient | ||||||
25 | utilization ratio (determined using the positive | ||||||
26 | percentage change from the rate year 2005 Medicaid |
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1 | inpatient utilization ratio to the rate year 2007 Medicaid | ||||||
2 | inpatient utilization ratio, as calculated by the | ||||||
3 | Department for the disproportionate share determination). | ||||||
4 | (4) In addition to rates paid for inpatient hospital | ||||||
5 | services, the Department shall pay to each Illinois | ||||||
6 | children's hospital an amount equal to 20% of the total | ||||||
7 | base inpatient payments paid to the hospital for services | ||||||
8 | provided in State fiscal year 2005 and an additional amount | ||||||
9 | equal to 20% of the base inpatient payments paid to the | ||||||
10 | hospital for psychiatric services provided in State fiscal | ||||||
11 | year 2005. | ||||||
12 | (5) In addition to rates paid for inpatient hospital | ||||||
13 | services, the Department shall pay to each Illinois | ||||||
14 | hospital eligible for a pediatric inpatient adjustment | ||||||
15 | payment under 89 Ill. Adm. Code 148.298, as in effect for | ||||||
16 | State fiscal year 2007, a supplemental pediatric inpatient | ||||||
17 | adjustment payment equal to: | ||||||
18 | (i) For freestanding children's hospitals as | ||||||
19 | defined in 89 Ill. Adm. Code 149.50(c)(3)(A), 2.5 | ||||||
20 | multiplied by the hospital's pediatric inpatient | ||||||
21 | adjustment payment required under 89 Ill. Adm. Code | ||||||
22 | 148.298, as in effect for State fiscal year 2008. | ||||||
23 | (ii) For hospitals other than freestanding | ||||||
24 | children's hospitals as defined in 89 Ill. Adm. Code | ||||||
25 | 149.50(c)(3)(B), 1.0 multiplied by the hospital's | ||||||
26 | pediatric inpatient adjustment payment required under |
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1 | 89 Ill. Adm. Code 148.298, as in effect for State | ||||||
2 | fiscal year 2008. | ||||||
3 | (c) Outpatient adjustment. | ||||||
4 | (1) In addition to the rates paid for outpatient | ||||||
5 | hospital services, the Department shall pay each Illinois | ||||||
6 | hospital an amount equal to 2.2 multiplied by the | ||||||
7 | hospital's ambulatory procedure listing payments for | ||||||
8 | categories 1, 2, 3, and 4, as defined in 89 Ill. Adm. Code | ||||||
9 | 148.140(b), for State fiscal year 2005. | ||||||
10 | (2) In addition to the rates paid for outpatient | ||||||
11 | hospital services, the Department shall pay each Illinois | ||||||
12 | freestanding psychiatric hospital an amount equal to 3.25 | ||||||
13 | multiplied by the hospital's ambulatory procedure listing | ||||||
14 | payments for category 5b, as defined in 89 Ill. Adm. Code | ||||||
15 | 148.140(b)(1)(E), for State fiscal year 2005. | ||||||
16 | (d) Medicaid high volume adjustment. In addition to rates | ||||||
17 | paid for inpatient hospital services, the Department shall pay | ||||||
18 | to each Illinois general acute care hospital that provided more | ||||||
19 | than 20,500 Medicaid inpatient days of care in State fiscal | ||||||
20 | year 2005 amounts as follows: | ||||||
21 | (1) For hospitals with a case mix index equal to or | ||||||
22 | greater than the 85th percentile of hospital case mix | ||||||
23 | indices, $350 for each Medicaid inpatient day of care | ||||||
24 | provided during that period; and | ||||||
25 | (2) For hospitals with a case mix index less than the | ||||||
26 | 85th percentile of hospital case mix indices, $100 for each |
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1 | Medicaid inpatient day of care provided during that period. | ||||||
2 | (e) Capital adjustment. In addition to rates paid for | ||||||
3 | inpatient hospital services, the Department shall pay an | ||||||
4 | additional payment to each Illinois general acute care hospital | ||||||
5 | that has a Medicaid inpatient utilization rate of at least 10% | ||||||
6 | (as calculated by the Department for the rate year 2007 | ||||||
7 | disproportionate share determination) amounts as follows: | ||||||
8 | (1) For each Illinois general acute care hospital that | ||||||
9 | has a Medicaid inpatient utilization rate of at least 10% | ||||||
10 | and less than 36.94% and whose capital cost is less than | ||||||
11 | the 60th percentile of the capital costs of all Illinois | ||||||
12 | hospitals, the amount of such payment shall equal the | ||||||
13 | hospital's Medicaid inpatient days multiplied by the | ||||||
14 | difference between the capital costs at the 60th percentile | ||||||
15 | of the capital costs of all Illinois hospitals and the | ||||||
16 | hospital's capital costs. | ||||||
17 | (2) For each Illinois general acute care hospital that | ||||||
18 | has a Medicaid inpatient utilization rate of at least | ||||||
19 | 36.94% and whose capital cost is less than the 75th | ||||||
20 | percentile of the capital costs of all Illinois hospitals, | ||||||
21 | the amount of such payment shall equal the hospital's | ||||||
22 | Medicaid inpatient days multiplied by the difference | ||||||
23 | between the capital costs at the 75th percentile of the | ||||||
24 | capital costs of all Illinois hospitals and the hospital's | ||||||
25 | capital costs. | ||||||
26 | (f) Obstetrical care adjustment. |
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1 | (1) In addition to rates paid for inpatient hospital | ||||||
2 | services, the Department shall pay $1,500 for each Medicaid | ||||||
3 | obstetrical day of care provided in State fiscal year 2005 | ||||||
4 | by each Illinois rural hospital that had a Medicaid | ||||||
5 | obstetrical percentage (Medicaid obstetrical days divided | ||||||
6 | by Medicaid inpatient days) greater than 15% for State | ||||||
7 | fiscal year 2005. | ||||||
8 | (2) In addition to rates paid for inpatient hospital | ||||||
9 | services, the Department shall pay $1,350 for each Medicaid | ||||||
10 | obstetrical day of care provided in State fiscal year 2005 | ||||||
11 | by each Illinois general acute care hospital that was | ||||||
12 | designated a level III perinatal center as of December 31, | ||||||
13 | 2006, and that had a case mix index equal to or greater | ||||||
14 | than the 45th percentile of the case mix indices for all | ||||||
15 | level III perinatal centers. | ||||||
16 | (3) In addition to rates paid for inpatient hospital | ||||||
17 | services, the Department shall pay $900 for each Medicaid | ||||||
18 | obstetrical day of care provided in State fiscal year 2005 | ||||||
19 | by each Illinois general acute care hospital that was | ||||||
20 | designated a level II or II+ perinatal center as of | ||||||
21 | December 31, 2006, and that had a case mix index equal to | ||||||
22 | or greater than the 35th percentile of the case mix indices | ||||||
23 | for all level II and II+ perinatal centers. | ||||||
24 | (g) Trauma adjustment. | ||||||
25 | (1) In addition to rates paid for inpatient hospital | ||||||
26 | services, the Department shall pay each Illinois general |
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1 | acute care hospital designated as a trauma center as of | ||||||
2 | July 1, 2007, a payment equal to 3.75 multiplied by the | ||||||
3 | hospital's State fiscal year 2005 Medicaid capital | ||||||
4 | payments. | ||||||
5 | (2) In addition to rates paid for inpatient hospital | ||||||
6 | services, the Department shall pay $400 for each Medicaid | ||||||
7 | acute inpatient day of care provided in State fiscal year | ||||||
8 | 2005 by each Illinois general acute care hospital that was | ||||||
9 | designated a level II trauma center, as defined in 89 Ill. | ||||||
10 | Adm. Code 148.295(a)(3) and 148.295(a)(4), as of July 1, | ||||||
11 | 2007. | ||||||
12 | (3) In addition to rates paid for inpatient hospital | ||||||
13 | services, the Department shall pay $235 for each Illinois | ||||||
14 | Medicaid acute inpatient day of care provided in State | ||||||
15 | fiscal year 2005 by each level I pediatric trauma center | ||||||
16 | located outside of Illinois that had more than 8,000 | ||||||
17 | Illinois Medicaid inpatient days in State fiscal year 2005. | ||||||
18 | (h) Supplemental tertiary care adjustment. In addition to | ||||||
19 | rates paid for inpatient services, the Department shall pay to | ||||||
20 | each Illinois hospital eligible for tertiary care adjustment | ||||||
21 | payments under 89 Ill. Adm. Code 148.296, as in effect for | ||||||
22 | State fiscal year 2007, a supplemental tertiary care adjustment | ||||||
23 | payment equal to the tertiary care adjustment payment required | ||||||
24 | under 89 Ill. Adm. Code 148.296, as in effect for State fiscal | ||||||
25 | year 2007. | ||||||
26 | (i) Crossover adjustment. In addition to rates paid for |
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1 | inpatient services, the Department shall pay each Illinois | ||||||
2 | general acute care hospital that had a ratio of crossover days | ||||||
3 | to total inpatient days for medical assistance programs | ||||||
4 | administered by the Department (utilizing information from | ||||||
5 | 2005 paid claims) greater than 50%, and a case mix index | ||||||
6 | greater than the 65th percentile of case mix indices for all | ||||||
7 | Illinois hospitals, a rate of $1,125 for each Medicaid | ||||||
8 | inpatient day including crossover days. | ||||||
9 | (j) Magnet hospital adjustment. In addition to rates paid | ||||||
10 | for inpatient hospital services, the Department shall pay to | ||||||
11 | each Illinois general acute care hospital and each Illinois | ||||||
12 | freestanding children's hospital that, as of February 1, 2008, | ||||||
13 | was recognized as a Magnet hospital by the American Nurses | ||||||
14 | Credentialing Center and that had a case mix index greater than | ||||||
15 | the 75th percentile of case mix indices for all Illinois | ||||||
16 | hospitals amounts as follows: | ||||||
17 | (1) For hospitals located in a county whose eligibility | ||||||
18 | growth factor is greater than the mean, $450 multiplied by | ||||||
19 | the eligibility growth factor for the county in which the | ||||||
20 | hospital is located for each Medicaid inpatient day of care | ||||||
21 | provided by the hospital during State fiscal year 2005. | ||||||
22 | (2) For hospitals located in a county whose eligibility | ||||||
23 | growth factor is less than or equal to the mean, $225 | ||||||
24 | multiplied by the eligibility growth factor for the county | ||||||
25 | in which the hospital is located for each Medicaid | ||||||
26 | inpatient day of care provided by the hospital during State |
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1 | fiscal year 2005. | ||||||
2 | For purposes of this subsection, "eligibility growth | ||||||
3 | factor" means the percentage by which the number of Medicaid | ||||||
4 | recipients in the county increased from State fiscal year 1998 | ||||||
5 | to State fiscal year 2005. | ||||||
6 | (k) For purposes of this Section, a hospital that is | ||||||
7 | enrolled to provide Medicaid services during State fiscal year | ||||||
8 | 2005 shall have its utilization and associated reimbursements | ||||||
9 | annualized prior to the payment calculations being performed | ||||||
10 | under this Section. | ||||||
11 | (l) For purposes of this Section, the terms "Medicaid | ||||||
12 | days", "ambulatory procedure listing services", and | ||||||
13 | "ambulatory procedure listing payments" do not include any | ||||||
14 | days, charges, or services for which Medicare or a managed care | ||||||
15 | organization reimbursed on a capitated basis was liable for | ||||||
16 | payment, except where explicitly stated otherwise in this | ||||||
17 | Section. | ||||||
18 | (m) For purposes of this Section, in determining the | ||||||
19 | percentile ranking of an Illinois hospital's case mix index or | ||||||
20 | capital costs, hospitals described in subsection (b) of Section | ||||||
21 | 5A-3 shall be excluded from the ranking. | ||||||
22 | (n) Definitions. Unless the context requires otherwise or | ||||||
23 | unless provided otherwise in this Section, the terms used in | ||||||
24 | this Section for qualifying criteria and payment calculations | ||||||
25 | shall have the same meanings as those terms have been given in | ||||||
26 | the Illinois Department's administrative rules as in effect on |
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1 | March 1, 2008. Other terms shall be defined by the Illinois | ||||||
2 | Department by rule. | ||||||
3 | As used in this Section, unless the context requires | ||||||
4 | otherwise: | ||||||
5 | "Base inpatient payments" means, for a given hospital, the | ||||||
6 | sum of base payments for inpatient services made on a per diem | ||||||
7 | or per admission (DRG) basis, excluding those portions of per | ||||||
8 | admission payments that are classified as capital payments. | ||||||
9 | Disproportionate share hospital adjustment payments, Medicaid | ||||||
10 | Percentage Adjustments, Medicaid High Volume Adjustments, and | ||||||
11 | outlier payments, as defined by rule by the Department as of | ||||||
12 | January 1, 2008, are not base payments. | ||||||
13 | "Capital costs" means, for a given hospital, the total | ||||||
14 | capital costs determined using the most recent 2005 Medicare | ||||||
15 | cost report as contained in the Healthcare Cost Report | ||||||
16 | Information System file, for the quarter ending on December 31, | ||||||
17 | 2006, divided by the total inpatient days from the same cost | ||||||
18 | report to calculate a capital cost per day. The resulting | ||||||
19 | capital cost per day is inflated to the midpoint of State | ||||||
20 | fiscal year 2009 utilizing the national hospital market price | ||||||
21 | proxies (DRI) hospital cost index. If a hospital's 2005 | ||||||
22 | Medicare cost report is not contained in the Healthcare Cost | ||||||
23 | Report Information System, the Department may obtain the data | ||||||
24 | necessary to compute the hospital's capital costs from any | ||||||
25 | source available, including, but not limited to, records | ||||||
26 | maintained by the hospital provider, which may be inspected at |
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1 | all times during business hours of the day by the Illinois | ||||||
2 | Department or its duly authorized agents and employees. | ||||||
3 | "Case mix index" means, for a given hospital, the sum of | ||||||
4 | the DRG relative weighting factors in effect on January 1, | ||||||
5 | 2005, for all general acute care admissions for State fiscal | ||||||
6 | year 2005, excluding Medicare crossover admissions and | ||||||
7 | transplant admissions reimbursed under 89 Ill. Adm. Code | ||||||
8 | 148.82, divided by the total number of general acute care | ||||||
9 | admissions for State fiscal year 2005, excluding Medicare | ||||||
10 | crossover admissions and transplant admissions reimbursed | ||||||
11 | under 89 Ill. Adm. Code 148.82. | ||||||
12 | "Medicaid inpatient day" means, for a given hospital, the | ||||||
13 | sum of days of inpatient hospital days provided to recipients | ||||||
14 | of medical assistance under Title XIX of the federal Social | ||||||
15 | Security Act, excluding days for individuals eligible for | ||||||
16 | Medicare under Title XVIII of that Act (Medicaid/Medicare | ||||||
17 | crossover days), as tabulated from the Department's paid claims | ||||||
18 | data for admissions occurring during State fiscal year 2005 | ||||||
19 | that was adjudicated by the Department through March 23, 2007. | ||||||
20 | "Medicaid obstetrical day" means, for a given hospital, the | ||||||
21 | sum of days of inpatient hospital days grouped by the | ||||||
22 | Department to DRGs of 370 through 375 provided to recipients of | ||||||
23 | medical assistance under Title XIX of the federal Social | ||||||
24 | Security Act, excluding days for individuals eligible for | ||||||
25 | Medicare under Title XVIII of that Act (Medicaid/Medicare | ||||||
26 | crossover days), as tabulated from the Department's paid claims |
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1 | data for admissions occurring during State fiscal year 2005 | ||||||
2 | that was adjudicated by the Department through March 23, 2007. | ||||||
3 | "Outpatient ambulatory procedure listing payments" means, | ||||||
4 | for a given hospital, the sum of payments for ambulatory | ||||||
5 | procedure listing services, as described in 89 Ill. Adm. Code | ||||||
6 | 148.140(b), provided to recipients of medical assistance under | ||||||
7 | Title XIX of the federal Social Security Act, excluding | ||||||
8 | payments for individuals eligible for Medicare under Title | ||||||
9 | XVIII of the Act (Medicaid/Medicare crossover days), as | ||||||
10 | tabulated from the Department's paid claims data for services | ||||||
11 | occurring in State fiscal year 2005 that were adjudicated by | ||||||
12 | the Department through March 23, 2007. | ||||||
13 | (o) The Department may adjust payments made under this | ||||||
14 | Section 12.2 to comply with federal law or regulations | ||||||
15 | regarding hospital-specific payment limitations on | ||||||
16 | government-owned or government-operated hospitals. | ||||||
17 | (p) Notwithstanding any of the other provisions of this | ||||||
18 | Section, the Department is authorized to adopt rules that | ||||||
19 | change the hospital access improvement payments specified in | ||||||
20 | this Section, but only to the extent necessary to conform to | ||||||
21 | any federally approved amendment to the Title XIX State plan. | ||||||
22 | Any such rules shall be adopted by the Department as authorized | ||||||
23 | by Section 5-50 of the Illinois Administrative Procedure Act. | ||||||
24 | Notwithstanding any other provision of law, any changes | ||||||
25 | implemented as a result of this subsection (p) shall be given | ||||||
26 | retroactive effect so that they shall be deemed to have taken |
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1 | effect as of the effective date of this Section. | ||||||
2 | (q) For State fiscal years 2012 and 2013, the Department | ||||||
3 | may make recommendations to the General Assembly regarding the | ||||||
4 | use of more recent data for purposes of calculating the | ||||||
5 | assessment authorized under Section 5A-2 and the payments | ||||||
6 | authorized under this Section 5A-12.2. | ||||||
7 | (Source: P.A. 95-859, eff. 8-19-08; 96-821, eff. 11-20-09.)
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